By Day 3 of Week 11
Post a brief description of the situation you experienced and explain how incorporating or not incorporating patient preferences and values impacted the outcome of their treatment plan. Be specific and provide examples. Then, explain how including patient preferences and values might impact the trajectory of the situation and how these were reflected in the treatment plan. Finally, explain the value of the patient decision aid you selected and how it might contribute to effective decision making, both in general and in the experience you described. Describe how you might use this decision aid inventory in your professional practice or personal life.
By Day 6 of Week 11
Respond to at least two of your colleagues on two different days and offer alternative views on the impact of patient preferences on treatment plans or outcomes, or the potential impact of patient decision aids on situations like the one shared.
Discussion – Week 11
Last year I took care of a covid patient that also had liver cancer. His prognosis was extremely poor due to the patient also having metastatic liver cancer. This patient had it all over his body including his brain. The peculiar thing was that the patient did not know that he had cancer. The family refused to tell him that he had cancer and just told him that he was in bad shape because of covid. The patient did not speak English and the family would only translate what they wanted and, in some cases, make up things. I know because I speak Spanish and as the doctor would speak and I translate, they would stop me, and they would translate. This situation was an ethical dilemma because the doctor wanted to tell the patient what was going on and discuss medical options, but the family would not let him. Code status also needed to be addressed but again the family interrupted.
It was not until the family left to eat one day that the doctor was able to speak with the patient and informed him everything that was going on. My patients family loved him so much, but they were committing a huge injustice. The physician wanted to discuss shared decision making (SDM), a process where the doctor and patient discuss medical options, possible outcomes, things that can go wrong, and the patients wishes (Driever et al., 2022). The patient was alert, oriented, coherent, and capable of making his own decisions. The family wanted him to fight through covid and then they would tell him he had cancer, but I honestly believe he did not make it too long. It is hard to see family go through such horrible pain but as healthcare professionals, we have sworn to protect our patients and cause no harm. Patients that are more involved in their care, know the consequences of each decision, and are boldly willing to try new treatments are in better control of their health and go through less decision-making conflict (Hahlweg et al., 2020).
Eventually, the doctor and I were able to discuss code status with the patient and he wanted to remain a full code. He was only 45 years-old. Code status is such a personal decision and family is usually against DNR orders, but that is why physician and patient conversations are vital. The Ottawa personal decision guide is a great tool for situations that are not as severe as my patients situation. I will certainly be recommending this tool to some of my patients who would benefit from this questionnaire and make the decision that best fits their situation.
Reference
Driever, E. M., Stiggelbout, A. M., & Brand, P. L. P. (2022). Patients’ preferred, perceived decision-making roles, and observed patient involvement in videotaped encounters with medical specialists. Patient Education and Counseling. https://doi.org/10.1016/j.pec.2022.03.025
Hahlweg, P., Kriston, L., Scholl, I., Brähler, E., Faller, H., Schulz, H., Weis, J., Koch, U., Wegscheider, K., Mehnert, A., & Härter, M. (2020). Cancer patients’ preferred and perceived level of involvement in treatment decision-making: an epidemiological study. Acta Oncologica (Stockholm, Sweden), 59(8), 967–974. https://doi.org/10.1080/0284186X.2020.1762926
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/
7 months ago
Sarah Lockwood
RE: Discussion – Week 11
Hello Claudia,
thank you for your post. I am sorry you had to experience that situation, as well as the patient and his family. Unfortunately, I have witnessed similar situations. I agree, if a patient is completely coherent and capable of making his or her own decisions, it is his or her right. Families, especially non-medical, seem to have a more difficult time accepting terminal illnesses and try to lengthen the time they have with the patient. According to Melnyk & Fineout-Overholt (2018), patient-centeredness requires the patient’s preferences and values to guide all decisions. Additionally, it places an intentional focus on needs, wants, and desires of the patient. Unfortunately, the family did not consider patient-centered care. To assist family members with accepting end-of-life decisions of their terminal loved one, The Ottawa Hospital Research Institute (2021) provides support tools to guide shared decision making. The tools can help families understand the reality of the situation but more importantly, educated families on making patient-centered decisions.
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare:
A guide to best practice (4th ed.). Philadelphia, PA: Wolters Kluwer.
Ottawa Hospital Research Institute. (2021). Patient decision aids. Retrieved on May 12, 2022,
from https://decisionaid.ohri.ca/docs/das/Critically_Ill_Decision_Support.pdf.
7 months ago
Memory Rinomhota
RE: Discussion – Week 11
It is crucial to learn and understand patients’ cultures and beliefs. I work in a jail, and one day I noticed that one of my patients, who is usually compliant with his medication regimen, did not come for his night medication. I called him and asked why he was not taking his medication. He told me that he is a Muslim and does not take anything between 6 am and 6 pm. Medication pass in the jail is done twice a day, at 8 am and 8 pm. Pt said that he had not taken his medication in two days because it was the Ramadan period, and the drug came late. The patient had not reported his concerns to the nurse because he thought no one would help him. I contacted the provider and explained the situation. The provider agreed to change the medication from 6 am to 6 pm. The nurses were advised of the changes during the huddle, and the patient received his medication. Pt was educated on how to make his need known and get involved in the treatment plan.
Incorporating the patient’s culture and treatment plan preferences helps the patient understand what is going on and comply with the treatment plan. The patient can ask questions and seek clarification which motivates them to take charge. The promotion of patient participation in decision making helps patients get involved in the treatment plan (Zang et al., 2022)
Patient educated on contacting the nursing staff and freely voicing his concerns is necessary. Implementing shared decision-making builds trust between the patient and healthcare worker and improves the quality of care and effectiveness (Giuliani et al., 2020). I will use the decision to educate the patient to be forthcoming and ask questions for clarification. The patient will have an informed decision and trusts the process, and participate in the planning of care
Reference
Chenel, V., Mortenson, W. B., Guay, M., Jutai, J. W., & Auger, C. (2018). Cultural adaptation and validation of patient decision aid: a scoping review. Patient preference and adherence, 12, 321–332. https://doi.org/10.2147/PPA.S151833
Giuliani, E., Melegari, G., Carrieri, F., & Barbieri, A. (2020). Overview of the main challenges in shared decision making in a multicultural and diverse society in the intensive and critical care setting. Journal of Evaluation in Clinical Practice, 26(2), 520-523.
Zang, Y., Liu, S., & Chen, Y. (2022). Qualitative study of willingness and demand for participation in decision-making regarding anticoagulation therapy in patient undergoing heart valve replacement. BMC Medical Informatics & Decision Making, 22(1), 1–9. https://doi.org/10.1186/s12911-022-01780-2
7 months ago
Inderpreet Sandhar
RE: Discussion – Week 11
7 months ago
Christina Fisher
RE: Discussion – Week 11
7 months ago
Christina Fisher
RE: Discussion – Week 11
7 months ago
Tosin Addeh
RE: Discussion – Week 11
7 months ago
Sharon Muchina
RE: Discussion – Week 11
Patient Preferences and Decision Making
Patient Preferences can help clinicians make day-to-day treatment decisions by incorporating the patient preferences and values through a collaborative process known as Shared Decision Making (S.D.M.) (Kon et al., 2016).
While working in a rehabilitation facility, one of my post-operation patients had total knee replacement surgery. I found out that this patient’s pain hindered the therapists’ opportunity to provide physical and occupational therapy because of the patient’s unbearable pain. I notified the physician that the patient routinely took a specific pain medication at home and requested to try that pain medication 1 hour before therapy. The order got started, the patients’ pain was under control, and they could participate in all their therapy sessions without experiencing uncontrolled pain.
When jointly discussing healthcare decisions with patients, clinicians must consider the patients’ values, preferences, and circumstances to ensure that incorporating their preferences brings a beneficial outcome that is not harmful (Hoffmann et al., 2014). As a clinician, when other pain treatments did not seem to remedy the pain experienced, I asked the patient what pain medicine had worked best in managing pain in the past. I then communicated with the physician, who was willing to consider adding this medication for pain management into the care plan. Despite not being on the patients’ care plan, this medication was available for use.
I selected knee replacement surgery as the decision aid. Detailed information explaining what causes knee deterioration, like arthritis, is explained to the targeted audience with knee-related issues. The benefits and possible risks of knee replacement surgery, the expected recovery process, and the timeline of how fast the knee will heal are all explained in the patient decision aids (A to Z Summary Results – Patient Decision Aids).
The value of the patient decision aids for the clinician is that it creates educational awareness for the patients of what to expect in recovery post-operation. Nurses can use the decision aid inventory as a guide to reinforce specific recovery information like the expected length of therapy, pain management techniques, and activity levels. Nurses in rehab can give this information to all patients to use to self-assess the need to go for knee replacement surgery. The findings can then be discussed with physicians to determine the most effective treatment option.
References
A to Z Summary Results – Patient Decision Aids – Ottawa Hospital Research Institute. 2019, from https://decisionaid.ohri.ca/AZsumm.php?ID=1112
Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision-making. Jama, 312(13), 1295-1296.
Kon, A. A., M.D., Davidson, Judy E, D.N.P., R.N., Morrison, W., M.D., Danis, M., M.D., & White, Douglas B, M.D., M.A.S. (2016). Shared Decision-Making in Intensive Care Units: Executive Summary of the American College of Critical Care Medicine and American Thoracic Society Policy Statement. American Journal of Respiratory and Critical Care Medicine, 193(12), 1334-1336. https://www.proquest.com/scholarly-journals/shared-decision-making-intensive-care-units/docview/1797885427/se-2?accountid=14872
7 months ago
Janelle McEwen
RE: Discussion – Week 11
Two years ago, I was working with a female patient with type 2 diabetes mellitus (T2DM). The patient had been on metformin, which effectively controlled her blood glucose levels for over three years. She, however, required medication intensification after the three years to avoid clinical inertia, which is attributed to the health care professional’s knowledge, attitudes, and perceptions, as well as the patient’s beliefs that insulin leads to hypoglycemia, weight gain, and complications (Bailey et al., 2018). When I informed the patient of the need for trade-offs between benefits and risks associated with alternative medications to metformin used in intensification, her most valued treatment attribute was weight change instead of blood glucose controlled days (Huang et al., 2022). Failure to consider the patient treatment values would have negatively influenced her decision to adhere to the medication regimen, thereby resulting to hyperglycemic events, including unsteady glucose control, vomiting, excessive hunger and thirst, rapid heartbeat, vision problems, diabetic ketoacidosis, and hyperosmolar hyperglycemic state (Huang et al., 2022).
In line with the National Institute for Health and Care Execellence (2022) guidelines, I acknowledge that individual patients have the right to be involved in discussions and make informed decisions about their treatment and care with their healthcare team. Thus, I provided the relevant information that explains the treatment and care in a way they can understand, including the possibility of adverse events associated with uncontrolled hyperglycemia. The patient decision aid (PDA) facilitated treatment decisions in collaboration with clinicians, promoting shared decision-making. Her attitude changed and the most valued treatment attribute shifted to blood glucose controlled days, followed by the frequency of hypoglycemic events, medication regimen, weight change, and blood glucose monitoring. Since then, I have not handled any case of medication non-compliance with respect to the female patient.
I can apply the above PDA in my current practice to dispel patients’ preferences, which are, at times, influenced by misconceptions, fear, and personal anecdotes not applicable to an individual’s circumstances, and empower them to develop informed clinical decisions and embrace self-care and self-management skills.
References
Bailey, R. A., Shillington, A. C., Harshaw, Q., Funnell, M. M., VanWingen, J., & Col, N. (2018). Changing patients’ treatment preferences and values with a decision aid for type 2 diabetes mellitus: Results from the treatment arm of a randomized controlled trial. Diabetes Therapy, 9(2), 803–814. https://doi.org/10.1007/s13300-018-0391-7
Huang, Y., Huang, Q., Xu, A., Lu, M., & Xi, X. (2022). Patient preferences for diabetes treatment among people with type 2 diabetes mellitus in China: A discrete choice experiment. Frontiers in Public Health, 9(February), 1–9. https://doi.org/10.3389/fpubh.2021.782964
National Institute for Health and Care Execellence. (2022). Patient decision aid: Type 2 diabetes in adults: Management. https://www.nice.org.uk/guidance/ng28/resources/patient-decision-aid-2187281197
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Discussion – Week 11
I am so glad that you all were in my course section this term. It has been a joy to work with you, and I hope you take away with you the skills you need for you MSN role. (It will happen before you know it!)
I watched the Carol Burnett Show every week when I was small- and I still watch reruns. She always sang this song at the end of each show that seems fitting to share the last week of the course.
As sung by Carol Burnett: http://www.youtube.com/watch?v=PjQuZCTLAv4
Dr. B.
7 months ago
Christina Fisher
RE: Discussion – Week 11
A situation where a patient’s preference or values were not incorporated into their treatment plan was when a patient’s religious values were not accommodated by staff. A female patient was admitted to our inpatient mental health hospital. Upon admission, she was asked to remove her head covering as the length of the material is a potential ligature risk, and her hair needed to be inspected for lice. It was never explained to her why it was part of our process to have her remove this, and after the assessment, it was not returned. The patient did not speak up about this; her husband brought it up after their first phone call. It was explained to the patient why the process was, the staff apologized, and she resumed wearing it. The importance of safety in the hospital was explained to her, and she was understanding of the extra precautions that were necessary while she was wearing it. Unfortunately, the patient’s trust and view of the hospital’s competence were damaged by this happening. While the patient was understanding and appreciative of the situation being remedied, it still took additional time to build rapport with her. Had her husband not spoken up, her religious beliefs and values may have been overlooked during her entire stay. If this had been the case, the patient might not have received the treatment she needed or had not gotten the care she required. For example, setting aside time from groups for prayer and dietary requests would not have been honored.
Including patient preference helps to build rapport with a patient. While it is challenging to be in a mental health hospital, the staff still treats those patients with dignity and respect. This is shown in the treatment plan by accommodating religious needs and preferences. Respect for a patient’s culture and religious beliefs helps the patient to feel more accepted, especially in a field with so much stigma surrounding it. Dobransky (2020) states, “Not only might these individuals have a negative self-evaluation and expect rejection, but they also experience discriminatory behavior from others in terms of jobs, housing, and general interactions” (p.249). It takes much courage to seek mental health treatment, yet patients are faced with not only the stigma of seeking help but of having received help. It is monumental that the staff makes the patients feel accepted.
This led to effective decision-making in this situation because the patient did not have to worry about maintaining their religious beliefs while hospitalized, and this allowed her to focus on the treatment that she needed. In general, including patient preferences and values in the treatment plan increases compliance because that patient feels valued. According to Reed et al. (2020), “The current research is among the first to have identified that patient values, both strength, and type, may play a role in treatment compliance and outcomes” (p. 99). Therefore, the outcomes will be better by including patients’ preferences in the treatment plan and including patients in the decision-making process.
I would use this decision aid inventory in both my professional and personal career by utilizing it when treating patients and when I am interacting with those in my personal life, especially when I am asked for advice as a nurse. The Ottawa Hospital Research Institute (2019) states “Patient decision aids are tools that help people become involved in decision making by making explicit the decision that needs to be made, providing information about the options and outcomes, and clarifying personal values.” This decision aid would be most helpful in providing resources for patients and inspiring them to better understand what they are experiencing.
References:
Dobransky, K. M. (2020). Reassessing mental illness stigma in mental health care: Competing stigmas and risk containment. Social Science & Medicine, 249. https://doi.org/10.1016/j.socscimed.202.112861.
Reed, P. Whittall, C. M., Osborne, L. A., & Emery, S. (2020). Impact of Strength and Nature of Patient Health Values on Compliance and Outcomes for Physiotherapy Treatment for Pelvic Floor Dysfunction.Urology, 136, 95-99. https://doi.org/10.1016/j.urology.2019.11.017.
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from https://decisionaid.ohri.ca/index.html
7 months ago
Janelle McEwen
RE: Discussion – Week 11
Christina, I enjoyed your insightful post. The scenario you described displays the inclination of nurses to disregard the values and preferences of mentally ill patients. I agree with you that failure to consider the patient’s views declines nurse-patient rapport and inculcates mistrust, thereby hindering the formation of a therapeutic relationship that is pertinent in clinical decision-making (Bailey et al., 2018). Kraetschmer et al. (2019) investigated how patients’ trust in their physician relate to their preferred role in medical decision-making. The findings showed that familiarity with a clinical condition increases desire for a shared (as opposed to passive) role. Shared decision-making often accompanies, and may require, a trusting patient–physician relationship.
References
Bailey, R. A., Shillington, A. C., Harshaw, Q., Funnell, M. M., VanWingen, J., & Col, N. (2018). Changing patients’ treatment preferences and values with a decision aid for type 2 diabetes mellitus: Results from the treatment arm of a randomized controlled trial. Diabetes Therapy, 9(2), 803–814. https://doi.org/10.1007/s13300-018-0391-7
Kraetschmer, N., Sharpe, N., Urowitz, S., & Deber, R. (2019). How does trust affect patient preferences for participation in decision-making ? Health Expectations, 7, 317–326.
7 months ago
Inderpreet Sandhar
RE: Discussion – Week 11
Health-care workers are encouraged to engage in evidence-based practice with a focus on patient-centered care. Sometimes it can be challenging for healthcare workers to try to consider the patients’ family members. Clinicians must act in patients’ best interest and use evidence-based decision-making, including their judgement to help patients make decisions (Melnyk & Fineout-Overholt, 2018). During my shift in the medical-surgical unit, I had assignment with a 52-year-old male with Type 2 diabetes accompanied by increased of cholesterol. During this experience, I had an opportunity to provide patient-centered care in which the patient cooperated with me during assessment. During the assessment process, we exchanged information between each other, thus developing trust and respect. The patient in this case raised a need, which is to reduce the levels of bad cholesterol associated with Type 2 diabetes and consequently prevent heart problems. This patient’s need influenced his quest for solutions.
Through building relationships, both the patient and nurse need to create a partnership when there is collaboration and power sharing. A collaborative treatment approach leads to better diagnostic tools and wellness incentives (Kelly, 2017). In this assessment, I got to know the patient and his specific preferences concerning the mode of treatment and therapy. According to the patient, subcutaneous injection worked well with his father, and he believed that it would work well with him as well. We reached an agreement and created a care plan that included daily subcutaneous injection. Besides, the patient provided all details including age, race, spiritual and cultural beliefs, education, as well as life experience. Besides, I was able to teach the patients concerning the type of exercise, diet, and medications to manage his kidney stone. The patient was able to teach me back using his own words, indicating that he understood what is entailed in his care. Implementing shared decision-making builds trust between the patient and healthcare worker and improves the quality of care and effectiveness (Giuliani et al., 2020).
References:
Giuliani, E., Melegari, G., Carrieri, F., & Barbieri, A. (2020). Overview of the main challenges in shared decision making in a multicultural and diverse society in the intensive and critical care setting. Journal of Evaluation in Clinical Practice, 26(2), 520-523.
Kelly, T. (2017). Shared decision-making: Reexamining the role of patient choice. https://www.beckershospitalreview.com/patient-experience/shared-decisionmaking- reexamining-the-role-of-patient-preference.html
Melnyk, B. M., & Fineout-Overholt, E. (2018). Evidence-based practice in nursing & healthcare: A guide to best practice (4th Ed.). Philadelphia, PA: Wolters Kluwer
7 months ago
Shirley Harleston
RE: Discussion – Week 11
Hello Inderpreet,
I enjoyed reading your post. It was concise and covered the basics. Building relationships does build trust. In your example, The 52-year-old gentleman was able to share his history and other information that were important in order for you to serve and care for him in the most valuable way. When shared decision-making is implemented it supports improved quality of care, and effective care as well as builds a trusting relationship between the patient and the health care worker. (Giuliani, 2020).
The Ottawa Hospital Patient decision aid summary is a means of making decisions with patient involvement. This tool asks questions about criteria to be defined as patient decisions, and criteria to lower the risk of making biased decisions. People exposed to decision aids feel more knowledgeable, better informed, and clearer about their values and risks. (Stacy, et al., 2017).
There are certain situations where shared decision-making is challenged such as cultural differences, educational background, language, and mental capacity. By engaging healthcare professionals with experts in communication, and patient representatives coming from different cultural backgrounds, languages, and education, healthcare professionals will be guided through the process, ensuring all patients receive a comparable level of engagement. (Giuliani, 2020)
Reference:
Giuliani, E., Melegari, G., Carrieri, F., & Barbieri, A. (2020). Overview of the main challenges in shared decision making in a multicultural and diverse society in the intensive and critical care setting. Journal of Evaluation in Clinical Practice, 26(2), 520-523.
Stacey D, Légaré F, Lewis KB. Patient Decision Aids to Engage Adults in Treatment or Screening Decisions. JAMA. 2017 Aug 15;318(7):657-658. doi: 10.1001/jama.2017.10289.
7 months ago
Chaquita Nichols
RE: Discussion – Week 11
7 months ago
Cory Legan
Main Discussion – Week 11
Patients are often turning to the internet to learn more about upcoming procedures. I believe this newfound knowledge leads to patient preferences. As a nurse, I try my best to honor the patient’s wishes. In the past, I have had a patient request to not have a foley catheter placed during surgery. They have read that this practice leads to an increased risk of infection. Their concerns are valid. Evidence based practice and patient preferences goes hand in hand, when caring for our patients (Walden University, LLC. (Producer), 2018).
If appropriate, I will always incorporate the patient’s preference in their plan of care. Listening to their concerns and advocating for their wishes has a positive impact on overall outcomes (Hoffman & et al, 2014). I believe it fosters a sense of control and fulfillment. The patient in this scenario was very pleased with his care and thanked us for honoring his request to not have a foley catheter during surgery.
Patients should be involved and have a say it their care. The Ottawa Personal Decision Guide would have been a useful tool in this situation (The Ottawa Hospital Research Institute, 2019). This guide helps analyze the benefits and the risks of choosing to decline a foley catheter during surgery (2019). In addition, this tool promotes comparison between possible choices and outcomes (2019). This tool could be used to make a variety of decisions, when regarding healthcare practice or personal matters.
References:
Hoffman, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between
evidence-based medicine and shared decision making. Journal of the American
Medical Association, 312(13), 1295–1296. doi:10.1001/jama.2014.10186
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from
https://decisionaid.ohri.ca/
Walden University, LLC. (Producer). (2018). Evidence-based Practice and
Outcomes [Video file]. Baltimore, MD: Author.
7 months ago
Matthew Cluderay
RE: Main Discussion – Week 11
Cory,
It is important to remember that patient’s need to have an active role in their own care and we need to listen to their preferences. I think so many times nursing tend to go on autopilot and try to do what they think is best without considering what the patient wants. There is a relationship between EVP and patient cultural preferences and as nurses we’re responsible for following the EBP (Walden University 2018).
I’ve used the Ottawa tool before at my job as my manager found it useful when she was going to school. I’ve scrolled through it for work but with a narrowed focus. Now for this class I’ve seen how expansive that tool really is.
Have a good weekend
-Matt
Walden University, LLC. (Producer). (2018). Evidence-based Practice and
Outcomes [Video file]. Baltimore, MD: Author.
The Ottawa Hospital Research Institute. (2019). Patient decision aids. Retrieved from
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: Main Discussion – Week 11
7 months ago
Janelle McEwen
RE: Main Discussion – Week 11
Cory, it is true that healthy literacy is a pertinent issue in the process of involving patient preferences and values in clinical decision-making. Ruhnke et al. (2020) recognize that the core elements of shared decision-making are physician sharing of information and patient participation in decisions, which may improve patient satisfaction and health outcomes. The above authors investigated the association of hospitalized patients’ desire to delegate decisions to their physician with care dissatisfaction. The findings showed that a desire to participate in decisions was associated with reduced satisfaction and less confidence and trust in the physicians providing treatment. The use of patient decision aids is definitely an effective plan to improve health literacy and their engagement in clinical decision-making. All the best in the subsequent courses!
Reference
Ruhnke, G. W., Tak, H. J., & Meltzer, D. O. (2020). Association of preferences for participation in decision-making with care satisfaction among hospitalized patients. JAMA Network Open, 3(10), 1–13. https://doi.org/10.1001/jamanetworkopen.2020.18766
7 months ago
Crystal Anderson
My initial Post
The ten years I have been in healthcare there is never a dull moment. I have taken care of many types of patients my ten years. I have had patients with End Stage Renal Disease, Alzheimer’s disease, Parkinson’s disease, Congestive Heart Failure and so much more. I have taken care of patients in both acute and long-term care settings. One patient I never would forget was a 95-year-old female, in the nursing home who had dementia with no living will or power of attorney who just had an acute ischemic stroke patient which paralyzed patient half of their body. Dementia is a major neurocognitive disorder. Some evidence suggests that people with dementia can still articulate their values, preferences, and choices in a reliable manner (Wilkins, 2017). Well Patient had very good support system and family wanted to take her home. During the pandemic with COVID 19 being in a nursing home was lonely, family was not allowed to visit so family did not want to send patient to nursing home. When asked by the patient if they wanted to go to nursing home or go home the patient wanted to go to nursing home, the patient did not want to be a burden to his/her family. Good clinical judgement integrates our accumulated wealth of knowledge from patient care experiences, one size does not fit all (Ginex, 2018). Patient preferences can be religious values, social and cultural values, personal beliefs about health. When the patients are not included in their plan of care, there is a disconnect with the disease process. Since patient was able to make her own decisions still the family respected the patients’ preferences and let her choice the opition of going to nursing home. But if the patient was unable to make her own decision the patient decision aids would be great tools to help people become involved in decision making. I have seen some family members overturn dementia patients’ choices because they think the patient is not in their right mind especially when the patient becomes older in age. One day if I ever was faced with tough decisions I would utilize decision aides to help make clinical decisions.
Reference
Ginex, P. (2018). Integrate Evidence with Clinical Expertise and Patient Preferences and Values. ONS Voice. https://voice.ons.org/news-and-views/integrate-evidence-with-clinical-expertise-and-patient-preferences-and-values
Wilkins, J. (2017). Dementia, Decision Making, and Quality of Life. AMA Journal of Ethics. https://doi.org/10.1001/journalofethics.2017.19.7.fred1-1707
7 months ago
Sharon Muchina
RE: The first response to Crystal
7 months ago
Sharon Muchina
RE: Reposting first response to Crystal
7 months ago
Memory Rinomhota
RE: My initial Post
7 months ago
Mary Bemker-page WALDEN INSTRUCTOR MANAGER
RE: My initial Post
7 months ago
Rona Adams
RE: My initial Post
Discussion Response 1
Crystal,
I enjoyed reading your discussion post this week. I currently work with the Medicare population, and some of my patients have Dementia. It is quite challenging if family members are involved in giving support or are just alone. One of my patients was diagnosed with Dementia. She resides with her son, who is in total denial and refuses to assist his mother. The social worker and I finally met with the son, who agreed to utilize the support services we put in place. One support service that we provided was a wrap-around service called the “Center for Successful Aging.” This program is patient-centered care that collaborates with therapists, providers, and other health care professionals to coordinate services for the aging population at one central location (MedstarHealth, 2022). Several phone calls later, the patient’s son still has not followed up; we even encouraged him to stop the patient from driving because she became lost numerous times. Also, the patient is taking a medication that needs to be monitored often to reduce the risk of bleeding or blood clots. The patient missed several appointments to have labs checked. I was very concerned. I encouraged the patient to seek another alternative medication that did not require ongoing follow-up, and she agreed. I explained the risk factors and benefits of the new medicine. Although my patient has Dementia, she can give informed consent regarding her healthcare needs. I agreed that using the decision aids are great tools to assist patients. According to Davies et al. (2019), “decision aids explicitly state the decision, provide information about the decision, and summarize options along with associated benefits and harms.”
References
Center-for-successful-aging [PDF]. (2022). https://www.medstarhealth.org/-/media/project/mho/medstar/services/geriatrics/center-for-successful-aging.pdf
Davies, N., Schiowitz, B., Rait, G., Vickerstaff, V., & Sampson, E. L. (2019). Decision aids to support decision-making in dementia care: A systematic review. International Psychogeriatrics, 31(10), 1403–1419. https://doi.org/10.1017/s1041610219000826
7 months ago
April Williams
RE: Discussion – Week 11
Discussion: Patient Preferences and Decision Making
Spending several years working in the nursing home setting with patients needing skill nursing services, it is important to understand the role of patient preference in meeting patient needs. According to Hoffman et al (2014), patient preference involve shared decision making of the clinicians and the patient and both are needed to provide the best care for patients. One of the criticisms of evidenced-based practice (EBP) is decisions do not often include the patient (Hoffman et al., 2014).
While working in the skilled nursing, the standardized workflow included weekly interdisciplinary team meeting to review patient needs and to plan for discharging the patient. Skilled nursing facilities are primarily short stay facilities that provide services including wound care, long-term antibiotics, physical therapy and occupational therapy. Patients are initially admitted very deconditioned and with consistency in nursing care and physical therapy, within a short period of time, the patient’s outlook improves and they are able to be discharged to home. Occasionally, the patient’s does not meet physical therapy goals or health status declines and new goals are needed to determine the next level of care for the patient. Through the interdisciplinary team process, the patient or family members are included in the meeting to participate in care decisions. Once the patient and family have a better understanding of the their health status, there is consensus regarding the next steps in care planning. However, when agreement cannot be reached or when patient’s request are unreasonable, there are occasions where Ethical Consults are placed to ensure shared decision making is developed based on the unified policy of the facility (Kon et al., 2016).
It is important to include the family and patient in care planning and critical when patient face multiple chronic medical conditions. The immediate impact of shared decision making (SDM) is providing dignity to the patient, gives the team insight into what are the next steps in care and provides humanistic care (Barton et al., 2020). In this scenario, patient Mr. Ed, an 86 y/o male was admitted for infected sacral pressure injury. The wound was acquired while in the home and under the a home care contract for the facility. Mr. Ed was malnourished, double amputee and wound infection included Osteomyelitis that requires IV antibiotics for 6-8 weeks, operating room for wound debridement, likely g-tube placement to meet increased nutritional needs and in-patient stay in skilled nursing facility to help with nutrition and wound care. More importantly, given the robust plan to assist with wound care, the patient was recently diagnosed with Stage 4 colon cancer. The family, (spouse) insisted on continuation with initial care plans. The interdisciplinary team agreed patient’s wound healing potential limited due to increased nutritional needs, recent cancer. limited mobility and multiple complicated health issues. Through the SDM process, the patient, spouse and daughters were brought in to discuss the patient’s plans to assist in determining next steps in the patient’s care. Unfortunately, the patient was referred to home hospice.
Through the process of SDM, using decision aids, the family was provided with information regarding Hospice, list of services that would be provided in the home. The decision aids provided the family with the opportunity to become educated about options and known outcomes to ensure the patient and family are a par to the team instead of decisions make by the healthcare provider (Ottawa Hospital Research Institute, 2019). Some examples of decision making tools included Hospice Brochure, samples of wound care products including wound vac machine, list of care to be performed by the family and care performed by home health nurse.
References
Barton, J. L., Kunneman, M., Hargraves, I., LeBlanc, A., Brito, J. P., Scholl, I., & Montori, V. M. (2020). Envisioning Shared Decision Making: A Reflection for the Next Decade. MDM policy
& practice, 5(2), 2381468320963781. https://doi.org/10.1177/2381468320963781
Hoffmann, T. C., Montori, V. M., & Del Mar, C. (2014). The connection between evidence-based medicine and shared decision making. JAMA, 312(13), 1295–1296.
https://doi.org/10.1001/jama.2014.10186
Kon, A. A., Davidson, J. E., Morrison, W., Danis, M., & White, D. B. (2016). Shared Decision-Making in Intensive Care Units. Executive Summary of the American College of
Critical Care Medicine and American Thoracic Society Policy Statement. American journal of respiratory and critical care medicine, 193(12), 1334–1336.
https://doi.org/10.1164/rccm.201602-0269ED
The Ottawa Hospital Research Institute (2019). Patient decision aids Retrieved from https://decisionaid.ohri.ca/
7 months ago
Chaquita Nichols
RE: Discussion – Week 11
Great post April,
I worked in a nursing home, and we had to learn the patient to properly take care of them. Most patients preferred a certain pudding with their medications, or they liked taking their medications before breakfast. A lot of the patients that come to the hospital know what works for them, so instead of going by just what we know as healthcare professionals, we must learn to listen to and work with our patients. Shared decision making is when the clinician involves the patient in their healthcare decision in which they go over patient values and preferences and if it is combined with Evidenced-based medicine, it can provide good patient outcomes (Hoffman, Montori, & Del Mar, 2014).
I also agree that it is especially important to involve the family in the care of the patients, especially if they are a useful source of support. Melnyk and Fineout-Overholt (2018) noted “Evidence-based practice is the integration of patient preferences and values, clinical expertise, and rigorous research to make decisions that lead to improved outcomes for patients and families” (pg. 2019). So EBP is based not only on the patient outcomes but the family as well. I also agree that it is important to involve everyone that is caring for the patient such as physical and occupational therapy, dieticians, clinicians, etc, so that everyone is on the same page, so there are realistic outcomes. Paez, Forte, and Gabeiras noted “If the doctor–patient relationship and communication are strengthened to cover all issues relevant to the patient’s health and values, is it possible for him or her to achieve more autonomous decisions by this linkage of shared decision-making and patient-centered medicine” (2021)?
References
Hoffman, T. C., Montori, V. M., & Del Mar. (2014). The connection between evidence-based medicine and shared decision making. Journal of the American Medical Association, 312(13), 1295-1296. https://doi.org/10.1001/jama.2014.10186
Melnyk, B., & Fineout-Overholt, E. (2018). Evidence-Based Practice in Nursing Practice and Healthcare (4th ed.). Wolters Kluwer.
Páez, G., Forte, D. N., & Gabeiras, M. del P. L. (2021). Exploring the Relationship between Shared Decision-Making, Patient-Centered Medicine, and Evidence-Based Medicine. The Linacre Quarterly, 88(3), 272–280. https://doi.org/10.1177/00243639211018355
7 months ago
Adetokunbo Oluwatuyi
RE: Discussion – Week 11
Description of Situation
The situation I remember of a patient being brought into a decision regarding their treatment plan was around three or four years ago. The patient suffered from Alzheimer’s disease, she was asked about the current room that she stayed in, how it made her feel, and if there was anything that could be added to the room to make her feel more comfortable. She mentioned a couple of materials that were connected to her teenage years, pictures of her family members especially grandkids, and more things that made her feel happy. Incorporating the patient’s preference helped her to feel more comfortable and it helped to reduce the symptoms of her disease.
Impact of Patient Preferences
Including the patient’s preferences and values, helps to improve the situation. The patient feels more comfortable with the nurse and the other medical practitioners, with he or she having a part in their own treatment plan, they are more likely to trust you and are more willing to accept your own decisions since you accepted theirs (Krist et al., 2017). After the room was fully equipped with the patient’s request, her progress from then on was mostly positive, and we were always greeted with a smiling face.
Value of Patient Decision Aid
The patient decision aid is valuable because not only does the nurse have to make decisions but the patient gets involved in their own care as well. The patient’s care is not just completely dictated by someone else giving them a say in what they want and need is important (Vahdat et al., 2014). It helps for better relationships and better treatment plan results.
Use of Decision Aid
In my professional practice, I would make use of this decision aid by asking patients about the room they currently reside in and how to improve it to make them feel more at home or more comfortable (The Consumer Benefits of Patient Shared Decision Making, 2019). Most of the time it is materials from their place of residence that they ask for so that could be easily provided through a family member.
References
Krist, A. H., Tong, S. T., Aycock, R. A., & Longo, D. R. (2017). Engaging patients in decision-making and behavior change to promote prevention. Studies in health technology and informatics. Retrieved May 11, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6996004/
The Consumer Benefits of Patient Shared Decision Making. Healthcare Value Hub. (2019, May). Retrieved May 11, 2022, from https://www.healthcarevaluehub.org/advocate-resources/publications/consumer-benefits-patient-shared-decision-making
Vahdat, S., Hamzehgardeshi, L., Hessam, S., & Hamzehgardeshi, Z. (2014, January). Patient involvement in Health Care Decision Making: A Review. Iranian Red Crescent medical journal. Retrieved May 11, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964421/
7 months ago
Inderpreet Sandhar
RE: Discussion – Week 11
Great post Adetokunbo,
I agree that incorporating the patient’s preference helped them to feel more comfortable. Applying the preferences of patients and including their values can lead to positive impacts as it relates to their treatment plan. Including patient preferences and values might improve the trajectory of the situation. A collaborative treatment approach leads to better diagnostic tools and wellness incentives (Kelly, 2017). The statement implies that nurses and doctors find the right information to plan their treatment procedures. Considering the views and preferences of the patient enhances the quality of EBP (Evidence Based Practice) in a healthcare setting. As healthcare professionals, we have a crucial role in shared decision making. While taking into consideration patients, goals, values, and preferences, we offer evidence-based decision and treatment (Carhuapoma & Hollen, 2018).
References:
Carhuapoma, L. R., & Hollen, P. J. (2018). The Use of Decision Aids for End-of-Life Surrogate Decision Making for Critically ill Stroke Patients: A Systematic Review. STROKE, 49. https://doi.org/10.1161/str.49.suppl_1.TP360
Kelly, T. (2017). Shared decision-making: Reexamining the role of patient choice. https://www.beckershospitalreview.com/patient-experience/shared-decisionmaking-reexamining-the-role-of-patient-preference.html
7 months ago
Rona Adams
RE: Discussion – Week 11
Main Posting–Patient Preferences and Decision Making
One patient experience I recall involved a male patient in his mid-fifties informed by his provider that his hemoglobin A1c was 15.3 and he needed to be placed on insulin right away. The patient told his provider that it was necessary to consider all his options and that he did not want to decide out of fear. The provider explained the risk factors associated with not taking insulin and how it could lead to kidney failure, death, loss of limbs, etc. This patient was very adamant and agreed to be seen the following week after deciding. The patient researched managing his diabetes and reducing his hemoglobin A1c within 60 days. When the patient returned to the primary care provider’s office, he informed his provider that he was okay and that taking insulin was a gimmick. He believed it was the provider’s way of making him depend on insulin, and he explained that insulin had killed his mother. The patient had ordered an herbal supplement from China to reduce his blood sugar, eats once daily, and drinks only water. He had also downloaded material from the internet guaranteeing that his hemoglobin A1c could be reduced by 50% in 60 days.
His health care provider advised against the decision and gave the patient material to review concerning his diabetes. The patient still refused, and the provider explained the consequences and agreed to have labs drawn in two months. Both agreed that if the patient reduces his hemoglobin A1c to 7.5 or less, he will not be prescribed insulin. According to Broome & Marshall (2021), share decision-making occurs after both the patient and healthcare provider collaborate to make a decision when all options have been reviewed, including the health risks, values, etc. Sixty days later the patient hemoglobin A1c had dropped to 6.3; however, 4 months later it increase to 14.2.
Providers and patients should work together to keep the patients healthy. “A patient’s relationship with a physician was a primary influence on whether he or she would accept or reject a clinical recommendation” (Stepanczuk et al., 2017). Many patients have less engagement with their health care provider due to self-diagnosis. They use the internet to diagnose themselves, and if a recommendation is made by their physician; more often than not it is being challenged.
In reviewing Ottawa’s patient decision aids, I found a tool for managing diabetes Type II or making the decision to take insulin or not. This decision aid could have assisted my patient with making an informed decision. According to The Ottawa Hospital Research Institute (2019), the patient could have better understood the severity of the condition and by having all the information another choice could have been made. Because the patient refused to take insulin he is currently receiving hemodialysis.
References
Broome, M. E., & Marshall, E. (2021). Frameworks for becoming a transformational leader. In Transformational leadership in nursing (3rd ed.). https://doi.org/10.1891/9780826193995.0006
Patient decision aids – ottawa hospital research institute. (n.d.). Retrieved 2019, from https://decisionaid.ohri.ca/
Stepanczuk, C., Williams, N., Morrison, K., & Kemmerer, C. (2017). Factors influencing patients’ receptiveness to evidence-based recommendations during the clinical encounter. Journal of Comparative Effectiveness Research, 6(4), 347–361. https://doi.org/10.2217/cer-2016-0077
7 months ago
Britny Ray
RE: Discussion – Week 11
Hey Rona,
Shared decision making takes a lot of time, patience and teamwork to have an effective outcome. It is great that the provider was open to letting the patient try his way at first and being open minded even though he disagreed. If clinicians make treatment decisions without attempting to understand the patient’s values, goals, and preferences, decisions will likely be predominantly based on the clinicians’ values, rather than the patient’s, and patients or surrogates may feel they have been unfairly excluded from decision-making (kon et al., 2016). I think having a tool aid to guide healthcare professionals in shared decision makeing can help make the process go smoother. For colorectal cancer screening, over 60 percent of individuals felt that use of the tool complimented their usual approach, increased patient knowledge, helped patients identify a preferred screening option, improved the quality of decision making, saved time and increased patients’ desire to get screened (schroy et al., 2014).
References
Kon, A. A., M.D., Davidson, Judy E,D.N.P., R.N., Morrison, W., M.D., Danis, M., M.D., & White, Douglas B,M.D., M.A.S. (2016). Shared decision-making in intensive care units: Executive summary of the american college of critical care medicine and american thoracic society policy statement. American Journal of Respiratory and Critical Care Medicine, 193(12), 1334-1336. Retrieved from https://www.proquest.com/scholarly-journals/shared-decision-making-intensive-care-units/docview/1797885427/se-2?accountid=14872
Schroy, P. C., Mylvaganam, S., & Davidson, P. (2014). Provider perspectives on the utility of a colorectal cancer screening decision aid for facilitating shared decision making. Health Expectations, 17(1), 27–35.
7 months ago
Rona Adams
RE: Discussion – Week 11
Britny,
Thank you for responding to my post. I do agree that healthcare professionals should use decision-making aids.
Rona
7 months ago
Britny Ray
RE: Discussion – Week 11
Clinicians and patients/surrogates should use a shared decision-making process to define overall goals of care (including decisions regarding limiting or withdrawing life-prolonging interventions) and when making major treatment decisions that may be affected by personal values, goals, and preferences (kon et.al, 2016). Health care and patients’ knowledge has changed ovr time with becoming even more advancede, so it is important that health care professionals and patients come to a common ground. I agree that sometimes a patients decision can either cost them quality of life terribly or actuallly benefit them in life.
In one situation it was a patient who came for a mammogram and it6 was discovered she had lump that needed to be biopsied. A screening mammogram is a proven early-detection test for breast cancer (healthwise.net, 2021), this can then help reduce the chances of the cancer becoming aggressive if chemotherapy or radiation is in the treatment plan. Although it could have been a false positive, this patient didn’t want to hear the worst possible news if it came to that so she never came for her biopsy. A year later she came down for a huge procedure to remove both her breast because it turned out to be cancer but it became aggressive. It even spread to other organs throughout her body.
In another situation a patients decision could be a better outcome for an individual. For example, a thirty year old female that has the BRCA-1 or 2 gene, she may hold off on getting a prophylactic mastectomy or oopherectomy because this can cause fertility problems if she wants children. Other issues involved are you will experience menopause if both ovaries are removed, this decreases sex drive and causes vaginal dryness (mayoclinic.org, 2022). This can be devastating for a woman that wants to still be sexually active with her significant other. This is where combined decision making can play a part. A clinician can suggest a fertility specialist before the procedure and hormone replacements as well.
References
Mayo Foundation for Medical Education and Research. (2022, February 11). Oophorectomy (ovary removal surgery). Mayo Clinic. Retrieved May 12, 2022, from https://www.mayoclinic.org/tests-procedures/oophorectomy/about/pac-20385030
Patient decision AIDS – ottawa hospital research institute. (n.d.). Retrieved May 12, 2022, from https://www.healthwise.net/ohridecisionaid/Content/StdDocument.aspx?DOCHWID=abp1927
Kon, A. A., M.D., Davidson, Judy E,D.N.P., R.N., Morrison, W., M.D., Danis, M., M.D., & White, Douglas B,M.D., M.A.S. (2016). Shared decision-making in intensive care units: Executive summary of the american college of critical care medicine and american thoracic society policy statement. American Journal of Respiratory and Critical Care Medicine, 193(12), 1334-1336. Retrieved from https://www.proquest.com/scholarly-journals/shared-decision-making-intensive-care-units/docview/1797885427/se-2?accountid=14872
7 months ago
Shontrice Davis
RE: Discussion – Week 11
I always say that sometimes patients know their bodies better than we do. I think it is important to always listen to what your patient is telling you. According to Bahl, Dollman, and Davison (2016), subjective data is important to make informed clinical decisions. For example, gathering patient medical and symptom history is important to make the most effective treatment plan for the patient. Including their preferences and values will yeild the most positive patien outcomes. I think patients should be included in determining their treatment plan because it has been proven that patient participation improves patient health outcomes (Vahdat et al., 2014).
I experienced how not incorparating the patient in their treatment plan can negativelty affect them. My coworker had a patient that was a very brittle diabetic. At bedtime, the patient had a blood glucose around 190. The patient explained to the nurse that she did not need any insulin. Because, even with a bedtime snack, her blood glucose would drop down to around 50. Well, the nurse insisted that the patient take the insulin because it was protocol. The patient trusted the nurse and agreed to take the insulin. The next moring, the patient was unconscious with a blood glucose of 20. They had to recieve dextrose 50%. In my opinion, this situation could have been avoided. The nurse should have listened to the patient and called the doctor to get permission to hold the insulin.
This situation is a perfect example of how important patient participation in care is. Their participation would have avoided this situation. This was not only a learning lesson for that nurse, but me as well. Patient participation is considered the goal of healthcare in today’s society to achieve top quality of care (Decelie, 2020).
References
DeCelie, I. (2020). Patient participation strategies: the nursing bedside handover. Patient Experience Journal. Retrieved May 14, 2022, from https://pxjournal.org/journal/vol7/iss3/15/
Vahdat, S., Hamzehgardeshi, L., Hessam, S., & Hamzehgardeshi, Z. (2014, January). Patient involvement in health care decision making: a review. Iranian Red Crescent medical journal. Retrieved May 14, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3964421/#:~:text=Patient%20participation%20means%20involvement%20of,and%20accepting%20health%20team%20instructions.
Bahl, J., Dollman, J., & Davison, K. (2016, November 19). The development of a subjective assessment framework for individuals presenting for Clinical Exercise Services: A delphi study. Journal of science and medicine in sport. Retrieved May 14, 2022, from https://pubmed.ncbi.nlm.nih.gov/26924803/